The first phase of the study, a regional cohort of 194 <750 gram birthweight survivors were evaluated at 5-9 years of age. Their school-age functioning was compared to that of preterm children with birth weights 750-1499 gm and to term born classmates. Each of the comparison groups was matched on age, sex and race to the <750 gm group. Follow-up data were gathered on growth and medical status, cognitive and neuropsychological performance, behavior, learning, and adaptive functioning, and parenting variables. The second and current phase, we are following the same three groups of children across 4 annual assessments (mean ages 11-14 years). Hypothesis 1: Disparities between the 3 groups will increase with the child's age, reflecting both a slower rate of skill acquisition in the <750 gm children and their increasing vulnerability to learning and behavior problems. Hypothesis 2: Age-related increases in the difficulties experienced by <750 gm children will be accompanied by increasing family distress and dysfunction. Group differences in family outcomes, therefore, will become more prominent with the child's age. Hypothesis 3: Multiple factors in addition to birthweight will help to identify those children at greatest risk for adverse developmental outcomes. Methods and analysis: Child evaluations include psychological and educational testing and questionnaires regarding child health and family functioning. Parents are interviewed at each assessment, and parents and teachers complete checklists and questionnaires regarding the child's behavior and school performance. Follow-up is annual, with the same procedures repeated at each assessment. Analysis will consist of multivariate comparisons of the <750 gm birthweight children to each comparison group, hierarchical regression analyses to examine relationships between predictor variables and change overtime, and path analysis to explore links between biological and environmental risks, cognitive neuropsychological skills, and behavior-learning-adaptive functioning.